Provider Demographics
NPI:1871532119
Name:BURDICK, BRENDA J (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:BURDICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:P O BOX 310001-0670
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0670
Mailing Address - Country:US
Mailing Address - Phone:575-758-6966
Mailing Address - Fax:575-751-5211
Practice Address - Street 1:1090 GOAT SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-1094
Practice Address - Country:US
Practice Address - Phone:575-758-7696
Practice Address - Fax:575-751-5211
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-02-20
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Provider Licenses
StateLicense IDTaxonomies
AK4641207Q00000X
CO31180207Q00000X
CODR0031180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine